Health System Research

Mamoona Kokab
Lecturer (Pharmacy Practice),
LPC
A Project of LMDC
 What is research?
• “Scientific and systematic search for information on
particular subject/issue”
• Embedded in epistemological (theory of knowledge) position
and theoretical framework.
• Collects essential evidence with the help of different
research methods.
 What is health system research?

• Part of research/health research,

• Results closely linked to health system.
• •Initially, it was known as health service research.
 Development of HSR

• In 1967, Division of Research in Epidemiology and

Communication Science (RECS) was established for research
works, under WHO.

• In 1972, RECS was restructured into Division of

Strengthening Health Services (SHS) and Health Services
Research responsibilities were transferred to Division of SHS.
• In 1980, WHO recognized and established Health System
Research with following mandates-

1. Promotion, coordination and information exchange in the

practice of HSR,
2. Strengthening of national capabilities for HSR training and
development
3. Support to substantive research in priority areas.
• In 2000, Health Policy and System Research was launched
to improve the performance of health systems.

• First time in 2002, under the umbrella of Health System

Research there was initiated a new sub area Public Health
System Reseach.
Health system

• All the organizations, people and actions whose primary

intent is to promote, restore or maintain health.” WHO
2000
Definition of HSR
• “The multidisciplinary field of scientific investigation that
studies how
 social factors,
financing systems,
 organizational structures and processes,
health technologies, and
personal behaviors affect ……………..
• access to health care, the quality and cost of health care,
and ultimately our health and well-being.
• Its research domains are individuals, families, organizations,
institutions, communities, and populations.”
 Concern of HSR
• Prime concern of HSR is to provide information for decision
making that can improve the functioning of the health
system
 Objective of HSR

To provide health managers at all levels, as well as

community members, with the relevant information they
need to make decisions on health-related issues and problems
they are facing with the aim to improve health system for a
health society
 Importance of HSR
• It is needed to-
• Strengthen the health care
• Work with real field problems
• Use variety of research disciplines
• Apply practical scientific knowledge for improving health
care and health status.
 Research skills

“Research skills refer to the ability to search for, locate,

extract, organise, evaluate and use or present information
that is relevant to a particular topic”
 Skills of Research Methods

• Research Skills, focuses on how you can gain knowledge of

research methodologies in their respective discipline and
interpret research findings.
(1) Knowledgeable and Skilled in
Disciplines

Comprehensive knowledge and skills relating to the

disciplines

Capacity to find, evaluate and use information (information

litraracy)

Ability to apply discipline/professional skills and knowledge

in the workplace (Professsional skills)
(2) Effective Communicators and Team
Members
Capacity to communicate effectively with others orally (Oral
Communication )
Capacity to communicate effectively with others in writing
(Written Communication )
Capacity to communicate effectively with others using,
multimedia, visual, musical and other forms appropriate to
their disciplines ( Communication Skills)
Capacity to interact and collaborate with others effectively,
including in teams, in the workplace, and in culturally or
linguistically diverse contexts ( Teamwork Skills )
(3) Innovative and Creative, with Critical Judgement

• Ability to use knowledge and skills to devise solutions to

unfamiliar problems ( Creativity and Innovation)

• Knowledge of research methodologies in their disciplines

and capacity to interpret findings (Research Skills )
(4) Socially Responsible and Engaged in
their Communities

• Ethical awareness (professional and personal) (Ethical

Behaviour and Social Responsibility)

• Capacity to apply disciplinary knowledge to solving real life

problems in relevant communities (Problem Solving)

• Understanding the value of further learning and professional

development( Further Learning )
(5) Competent in Culturally Diverse and
International Environments

• A global and international perspective on their

disciplines(Global and International Perspective and
Awareness)
Epidemiological study design
Steps/Process of HSR
1. Define Research Problem
2. Literature review(Review Previous finding)
3. Generate Research question
4. Research Design and executive Plan
5. Execute Research Project
6. Analyze and Interpret Results
7. Submit Report
8. Disseminate results
9. Seminar/Workshop
10. Publications
 Example
1. What is the Healthcare seeking behavior and barriers in accessing
healthcare of young adults in Lahore, Pakistan
2. I studied previous Research Articles
3. I generated different research questions
4. My research design was questionnaire based Cross sectional study
5. Started research project
6. Collect the data and put in the SPSS and find percentages
7. I prepared the result
8. I disseminated the result in the form of Thesis
9. No seminar
10. Publication in Process
Research Design
• It is considered as a
"blueprint" for research,
dealing with at least four
problems:
1. which questions to study.
2. which data are relevant.
3. How to collect data. and
4. How to analyze and
interpret the data.
1. Self medication
2. Questions about self
medication
3. Questionnaire, Collection
of data from Population
4. SPSS
Types of Study Designs
(1) Non- Intervention Studies
 (2) Descriptive studies

• It involves describing the characteristics of a particular

situation, event or case, such as- physical, socio-economic
and cultural, behavioral, etc.
• It can be carried out on a small or larger scale-
• 1. Small scale: case studies
• 2. Large scale: surveys/census
• (Note: one time data collection
 (1) Exploratory Studies

• It is a small-scale study of relatively short duration, which is

carried out when little is known about a situation or a
problem.
• It may include description as well as comparison.

• E.g. piloting studies, small scale comparative studies

 (3) Comparative or analytical studies

• It attempts to establish causes or risk factors for certain

problems by comparing two or more groups, some of which
have or develop the problem and some of which have not.
• It can be carried out as follows-
(A) Cross-sectional comparative studies
(B) Case – control studies
(C) Cohort studies
(a) Cross-sectional comparative studies

• It is a type of survey focus on describing as well as

comparing groups.
• Researchers wish to determine the role of independent
variable to dependent variable.
• (Note: relationship between variables)
e. g How the income affect the health status of the
populations
 (b) Case – control studies

• Investigator compares one group among whom the problem

that he wishes to investigate is present, and another group
called a control or comparison group, where the problem is
absent, in order to find out what factors have contributed to
the problem.
 (c) Cohort studies

• 
• In a study, a group of individuals that is exposed to a risk
factor (exposed group) is compared to a group of individuals
not exposed to the risk factor (non-exposed group).
• The researcher follows both groups over time and compares
the occurrence of the problem.
(2) Intervention Studies
 (1) Experimental Studies

 
• In this study, individuals are randomly allocated to at least
two groups.
• One group is subject to an intervention, or experiment,
while the other group(s) is not.
• The outcome of the intervention is obtained by comparing
the two groups.
 (2) Quasi-experimental studies

• It is missing either randomization or the use of a separate

control group.
• However, it always includes the manipulation/ intervention
(3) Pre test-post test experimental studies

• It is quite easy to set up because uses only one group.

• The situation is analyzed by comparing before and after the
intervention.
 (4) Pre-Test and Post-Test Surveys
• are a common practice in the surveying world. In the Pre-
Test survey baseline data is collected. Then, at a later date,
the Post-Test survey collects follow-up information after
some treatment has been applied. Usually, survey
researchers would like for this data to be in the same survey
so that they can easily make data comparisons in the
analysis phase
Applications of various statistical
procedures in pharmacy and medical
research
 Statistics

• It is the science which deals with collection, Classification,

and tabulation of numerical facts as the basis for
explanation, description and comparison of phenomenon
 Biostatistics

• It is the branch of statistics concerned with mathematical

facts and data related to Biological events.
 Data

“ As a part of Clinical Practice or research, we deal with many

observations, which when systemically arranged, are called
Data”
• The process of Converting data into information require a
special approach called statistics.
• Statistics mean a measured or counted fact or piece of
information, stated as figure, such as height of 10 persons,
weight of baby etc.
 Application of Statistics

(A) In Physiology and Anatomy:

(1) To define what is normal or healthy in a population
E.g To find the limits of normality in variables such as
weight and Pulse rate in a population
(2) To find the differences between means and proportions of
normal at two places or in different periods.
E.g the mean height of the boys in gujrat is less than the
mean height in Punjab. Whether this difference is due to
chance or a natural variation or because of some other
factors such as better nutrition playing a part, has to be
decided
 (3) To find the correlation between two variables X and Y
such as height and weight.
• Whether weight increase or decrease proportionately with
height and if so, by how much, has to be found.
(B) In Pharmacology
(1)To find the action of drug.
A drug is given to animals or humans to see whether the
changes produced are due to the drug or by chance?

(2) To compare the action of two different drugs or two

successive dosage of the same drug

(3) To find the relative potency of a new drug with respect to a

standard drug
( C) In Medicine:

(1) To compare the efficacy of a particular drug, operation.

For this, the percentage cured, relieved or died in the
experiment and control groups, is compared and difference
due to chance or otherwise is found by applying statistical
techniques.

(2) To find an association between two attributes such as

cancer and smoking
An appropriate test is applied for this purpose.
 (3) To identify signs and symptoms of a disease or
syndrome.
e. g Cough in typhoid is found by chance and fever
• is found in almost every case.
The proportional incidence of one symptom or another
indicates whether it is a characteristic feature of the disease
or not.
(4) To test usefulness of sera and vaccines in the field –
Percentage of attacks or deaths among the vaccinated
subjects is compared with that among the unvaccinated ones
to find whether the difference observed is statistically
significant.
( 5) In epidemiological studies – the roleof causative factors is
statistically tested.
Deficiency of iodine as an important cause of goiter in a
community is confirmed only after comparing the
incidence of goiter cases before and after giving iodized salt.
(D) CLINICAL MEDICINE

1. Documentation of medical history of diseases.

2. Planning and conduct of clinical studies.
3. Evaluating the merits of different procedures.
4. In providing methods for definition of
5. ‘normal’ and ‘abnormal’.
(E) PREVENTIVE MEDICINE

1. To provide the magnitude of any health problem in the

community.
2. To find out the basic factors underlying the ill-health.
3. To evaluate the health programs which was introduced in
the community(success/failure).
4. To introduce and promote health legislation.
Tests in pharmacy with respect to causality assessment and
specificity and sensitivity tests (e.g., crude death rate, disease
specific death rate)